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嚴防冬季流感疫情  接種疫苗保障健康

相信市民仍然記得剛過去的流感季節的嚴峻情況，尤其是夏季流感季節的染病人數、入院人次及死亡人數均達警戒級別(共錄得576宗成人與流感相關而需入住深切治療部的個案，當中428人死亡；19宗兒童與流感相關而需入住深切治療部的個案，當中3人死亡)。

香港醫學會副會長暨促進防疫注射服務公私營融合專責委員會主席陳以誠醫生認為夏季流感的異常爆發，主要原因並不是疫苗失效，而是疫苗的效力一般有至少半年的保護力，但未必能維持至七月的夏季。

2016/17年度各疫苗計劃合共為合資格人士接種703,000劑疫苗，整體接種率均有上升。政府去年首次資助6歲至未滿12歲之學童，接種人數達57,000人，已有效減低學校和社區爆發。該項措施更是有助將冬季流感季節兒童的嚴重及入住深切治療部的人數由以往兩年的雙位數字(2014/15年度：26宗；2015/16年度：35宗)，大幅回落到今年9宗的單位數(當中一人死亡) 的重要因素。根據外地的研究，為學童接種流感疫苗，可大大減低缺席率和社區傳播。

疫苗的成效雖未可百分百準確預測，因為會受到不同因素影響，包括接種時間、流感季節的時間長短、及疫苗病毒株是否脗合等；但若疫苗病毒株脗合，保護力可達七至九成。為了令社區免疫力更顯著，香港醫學會呼籲除了有醫學原因不能接種疫苗的人士外，市民應該接種流感疫苗，保障自己和周圍的人的健康，尤其是長者方面。因為長者的免疫力比壯年青年等為弱，就算接種疫苗後抗體也較快失效，繼而失去抵抗力，成為高危的一群。若社區上其他人因接種疫苗而免於感染，無形中對高危的人士造成多一重間接保護。若有三成以上市民接種疫苗，就可令本港達到有效防止疫症爆發的社區免疫力。

香港醫學會過去向政府建議，資助小學生及懷孕母親接種流感疫苗，並資助長者接種肺炎十三價疫苗。本會樂見政府采纳以上建議增加疫苗資助，而令到因為流感引致死亡及嚴重個案數字得以減低；但本會認為仍有改善空間。

香港醫學會在今天下午舉行記者招待會，即場為幼稚園學生、教師及醫護人員注射流感疫苗。醫學會同時呼籲高危人士，例如患有心臟病、糖尿病、慢性肺病及腎病等慢性疾病人士，要及早接種疫苗。根據醫院管理局的資料，慢性疾病患者感染流感的死亡率達八成二，因為流感會加重他們身體的負荷，較易出現併發症。其他高危群組包括五十歲以上人士、懷孕婦女、智障人士、65歲以上長者、6個月至未滿12歲兒童和所有傷殘津貼受助人等，亦應儘早接種流感疫苗。

另外，世界衞生組織月前建議二零一八年南半球疫苗配方，將由《香港型》（類甲型/香港/4801/2014（H3N2）病毒）改為《新加坡型》（類甲型/新加坡/INFIMH－16－0019/2016（H3N2）病毒），引起公眾極度關注。有關建議是世衞為明年中南半球冬季而作出，而香港屆時亦已處於夏季。有鑑於今年夏季高峰期有多宗死亡及嚴重個案，超出冬季的個案。為維護民康，不讓歷史重演，政府應效法新加坡同時接種南、北半球疫苗的做法，在明年五至七月為本港高危人士提供資助及免費接種南半球流感疫苗。

除此之外，政府應該積極考慮透過預防醫療的投資，減低政府在公共醫療方面所承擔的開支（見附件）。本會樂見特首林鄭月娥女士在剛出爐的施政報告內表示會加強基層健康服務及預防工作，繼續推行和改善疫苗注射/資助計劃，並會推行政策減低流感大流行的風險和提升本港應對流感大流行的能力。已有充份的數據顯示，政府投放越多資源在預防醫療上，例如提供免費或以資助形式鼓勵更多市民接種流感疫苗，政府之後所需要承擔的公共醫療開支，例如藥物治療、急症室及醫院病房使用等，便會越少。

香港醫學會現向政府作出以下建議：

一、       政府應提供流感疫苗資助予現時建議的所有高危群組人士，包括所有慢性疾病人士和醫護人員。

二、       政府應增加資助予需要經常接觸學童和不同群眾的人士，包括教師及執法人員。

三、       政府應考慮透過預防醫療的投資，以減低其在公共醫療方面所承擔的開支。

四、       政府應考慮展開研究決定是否需要在夏季流感季節來臨前，為市民/資助市民注射南半球流感疫苗，提升免疫力，維護民康。

現時，接種疫苗是最佳及最安全的預防流感方法。除了注射流感疫苗外，在日常生活方面，市民亦不能鬆懈，必須注意個人衞生，包括保持室內空氣流通、在觸摸口鼻眼後一定要洗手、和有傷風咳嗽徵狀時須佩戴口罩。在流感高峰期時，市民，特别是長者和小童，更應盡量避免到人多擠迫的地方，以防受到感染。市民如對注射疫苗有任何疑問，應該先向家庭醫生尋求意見。

二零一七年十月三十日

編輯備忘：

香港醫學會成立於一九二零年，旨在聯繫政府、各公立醫療機構、大學及私人執業的醫務工作者，交流意見，團結一心。醫學會致力將最新的醫療資訊及醫務發展傳遞與會員，提倡會員遵行專業操守，進而服務社會，維護民康。

PRESS

RELEASE

30 October 2017

Get Vaccination, Well-Prepared for the Winter Influenza Season

One would not easy to forget the critical influenza situation in the past winter and summer seasons, particularly the alarming numbers of patients, hospital admissions and fatality in the summer flu surge (it was recorded 576 adults admitted to ICU for influenza-associated conditions, among which 428 turned fatal, while 19 children admitted to ICU due to influenza and 3 of them died). 

Dr. Alvin YS CHAN, Vice-President of the Hong Kong Medical Association (HKMA) cum Chairman of the HKMA Task Force on Vaccination PPI, opined that such unusual epidemic in summer season was not resulted from the low effect of influenza vaccine.  Vaccine usually protects one for at least 6 months but may not be in its full effect through the summer season. 

The overall number of vaccination under various vaccination schemes in 2016/17 Influenza Season was 703,000, indicating a growth of vaccination coverage.  The Government started last year to offer subsidy to children aged between 6 and 12, and the number of vaccination rose to 57,000. This measure has effectively diminished the epidemic in school settings and the community and helped to reduce the number of influenza-associated admissions to ICU during winter flu season; the ICU admission number was reduced from the previous double digits (2014/15: 26 cases; 2015/16: 35 cases) to single digit (9 cases with 1 fatal) this year.  Some overseas studies found vaccination to students can greatly reduce their absence rate and hence prevent epidemic outbreak in the community. 

It is probably difficult to have 100% certainty about the effectiveness of influenza vaccine, as there are several affecting factors including but not limit to time of vaccination, duration of flu seasons, and whether the vaccines contain the viruses match with those dominated in that seasons.  If the vaccines contain viruses match with those dominated, 70 – 90% protection could be provided. To achieve a better protection in the community, the HKMA appeal the public (except those who should not take vaccine for medical grounds) to get vaccination.  It is known that elderly develop less antibodies than other healthy adults, and the antibodies can drop rapidly as well.  If 30% of the population get vaccination, herd immunity can be built and elderly and high-risk groups can be protected as a result.

The HKMA has recommended the Government to provide vaccination subsidy for primary students and pregnant women and PCV13 for the elderly.  We are glad our recommendations were accepted, and with the measures the fatality and severe flu cases have been lowered.  However, we do see there is room for improvement in the subsidy schemes.

The HKMA organized a press conference this afternoon and provided on-site influenza vaccination service for kindergarten kids, teachers and healthcare professionals.  The HKMA would like to urge the people with chronic diseases, such as heart diseases, diabetes mellitus, chronic lung diseases and renal diseases, to get influenza vaccination.  Data from the Hospital Authority show that the fatality rate of patients with chronic diseases who had flu at the same time could reach 82% due to serious complications.  Other high-risk groups of influenza infection, including aged 50 or above, pregnant women, persons with intellectual disability, elderly aged 65 or above, children aged between 6 months and under 12, and disability allowance recipients should also get influenza vaccination as early as they can to protect their health.

World Health Organization months ago announced their recommendations of influenza vaccines for use in the 2018 southern hemisphere influenza season include A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus instead of A/Hong Kong/4801/2014 (H3N2)-like virus for northern hemisphere.  The HKMA understand why the public become concerned; but it should take note that when winter comes to the southern hemisphere, it is summer time of Hong Kong already.  In view of the summer flu surge this year, the Government should take reference to Singapore’s experience and provide vaccines for southern hemisphere as well.  

Moreover, the Government should make more active moves in investing preventive medicine, so that the public healthcare sector expenditure can be significantly reduced (see appendix).  The HKMA is glad to know the Chief Executive Mrs. Carrie LAM’s plan on improving vaccination programme/vaccination subsidy scheme, and implementing primary care in her first policy address.  Figures show that the more the Government put on preventive healthcare, e.g. offering free or subsidized vaccination to a larger population, the less the Government would need to pay for public health, e.g. drug treatment, usage of Accident & Emergency department and various wards, etc.    

The HKMA call for the Government on the followings:

1. To provide subsidy to all the high-risk groups that CHP recommended for influenza vaccination, including patients with chronic diseases and healthcare professionals.
2. To offer subsidy to those who deal with children and groups, e.g. teachers and law enforcement officers.
3. To proactively consider to invest more on preventive healthcare in order to reduce the expenditure on public health.
4. To investigate whether there is a need to provide influenza vaccine for the use in southern hemisphere to the public before the summer flu season.

Vaccination is still the best and a safe way for influenza prevention.  In addition to receiving influenza vaccination, people should also stay vigilant in personal hygiene for prevention.  Maintaining good indoor ventilation; washing hands after touching the mouth, nose and eyes; putting on a surgical mask when having respiratory symptoms, are all good measures.  During the peak flu seasons, members of the public, child and elderly in particular, should avoid going to crowded public places.  Last but not the least, the public should consult professional advice from their family doctors on influenza vaccination.

Notes to editors:

The Hong Kong Medical Association, founded in 1920, aims to bring together Hong Kong's government, institutional, university and private medical practitioners for an effective exchange of views and co-ordination of efforts.  The foremost objective of the Association is to safeguard and promote public health.  The Association speaks collectively for its members and aims to keep its members abreast of medical ethics, issues and advances around the world.  In fulfilling these goals, the association hopes to better serve the people of Hong Kong.